Comprehensive Guide to Common Sleep Disorders and Effective Treatments

the topic of this lecture will be sleep problems and disorders so let's start with a relatively common

sleep disorder which is insomnia so insomnia is defined by difficulty falling or staying asleep it has to

happen for at least three nights a week for at least one month's time this is by far the most common sleep disorder it

may be associated with symptoms of depression there are contributing factors associated with it including

things like our age drug use exercise mental status and bedtime routines for example as people get older insomnia

is more likely to happen when people use certain types of substances like caffeine for example they're more likely

to experience insomnia also if people are exercising too close to bedtime it might actually lead to insomnia having

bad bedtime routines also can contribute to insomnia in ways it will talk about in just a little bit

as far as treatment goes there are a number of strategies one is to use stress management techniques to reduce a

person's stress the idea is that that can alleviate insomnia there are also some changes in

problematic behaviors that may contribute to insomnia like poorer bedtime routines for example watching

television in bed uh looking at your cell phone in bed there are a number of things that people can do to help

improve the quality of their sleep and reduce the likelihood of suffering from insomnia

there are also cognitive behavioral therapies which focus on cognitive process and problem behaviors that also

have been shown to be very helpful for treating issues surrounding insomnia next up we want to talk about the

parasomnias and there are a number of them that we want to mention parasomnias involve unwanted motor

Behavior or experiences throughout the sleep cycle so somnambulism is also referred to as

sleepwalking sleepwalking is a relatively common issue it isn't indicative of any sort of underlying

psychological problems there are a lot of bits of folk or surrounding sleepwalking like for example that it's

really dangerous to awaken a sleepwalker that's not true it's usually safer to kind of gently wake up a sleep with a

sleepwalker than to let them wander about especially if there are dangerous

obstacles in the way like like stairs that they might fall down or something they may trip over again you want to be

gentle when you wake them up you don't want to startle them awake because being startled to wake under any circumstance

can can be unsettling um and unpleasant for for the person who's being awakened

usually sleepwalking occurs during slow wave sleep and we'll we'll see uh some we'll look at a graph later looking at

EEG activity and seeing where people typically are in terms of sleep stages when they're experiencing different

issues like sleepwalking this is usually a slow wave sleep on stage three stage four

next up is REM behavior disorder this involves the loss of muscle atonia or paralysis during REM sleep previously

during another lecture we talked about when people are dreaming when we're experiencing rapid eye movement sleep we

experience sleep paralysis basically our body kind of locks down and we don't move very much during our dreams prevent

us from acting on the content of our dreams so what happens with REM behavior

disorder is the sort of Rim paralysis that most of us experience doesn't happen for them or at least is not fully

complete so for people with REM behavior disorder they tend to engage in a lot of physical

activity during their REM sleep so for example there's a comedian named Mike Birbiglia who suffers from REM behavior

disorder and tells some really funny but unfortunately kind of traumatic sorts of stories for him about

issues with his Rim behavior disorder the most famous of these stories is that one time he was traveling to do a comedy

show I think he was in Texas I remember correctly he was staying at a La Quinta Inn and went to sleep and had a dream

about a missile being fired at the hotel he was staying at so in his dream he jumps out of the window to to get away

from this missile that's been fired at the hotel he wakes up uh after actually literally

jumping through the wind the Second Story window of the hotel room he was staying in and he says he wakes up as

he's kind of running across the parking lot he's all cut up from the glass and everything but this would be an episode

of Rim behavior disorder you or I if we don't have room behavior disorder if we had this sort of dream we might thrash a

little bit in our beds but we wouldn't be leaping out of bed and jumping through the window of our hotel room

so what happens with REM behavior disorder is the sleeper may act in accordance with green content so if they

believe they're being chased by a tiger or a missiles being fired at their hotel room they may run away from it

physically run away from it in their sleep there are treatments for REM behavior

disorder there are certain anti-anxiety meds that have been used it can be helpful with uh with reducing the

symptoms of REM behavior disorder and reinstituting the sort of Rim paralysis that we should be experiencing

there's also an issue called restless leg syndrome this involves really kind of uncomfortable Sensations in the legs

when people are trying to fall asleep that are relieved by moving the legs um and so this can be really uh

problematic for Sleep patterns because people may have these kind of weird uncomfortable Sensations in their arms

and legs so it's called restless leg syndrome but it also can happen in the arms as well and so these sorts of

really uncomfortable Sensations that require movement can prevent people from from either getting to sleep or staying

asleep for prolonged periods night terrors are another parasomnia these involve intense arousal and panic

that occur during non-rem sleep so it isn't that the person is having a really bad dream that's a nightmare

um and is a very different sort of experience nightmares happening during brim episodes because they involve the

dreams night terrors happen during non-rim sleep and typically aren't associated with much dream content

when people are experiencing night terrors the kind of prototypical situation is they yell or scream they

kind of sit bolt upright in bed and they're kind of staring Straight Ahead um this isn't indicative of any sort of

emotional problem so it doesn't mean that the person has it doesn't mean they're stressed or depressed or

anything of that sort there aren't very clear psychological or emotional correlates of Night Terrors rather it

seems like a simple kind of misfiring in the neural Machinery as as usually children are developing now this can

also happen in adults but it's more common in children what can happen is that the sleeper May

scream or attempt to escape from whatever it is that's going on even though it's not really a dream they're

just kind of having this this experience of intense arousal and panic sleep apnea is another fairly common

sleep disorder a sleep apnea occurs when individuals stop breathing during their sleep usually for 10 to 20 seconds or

even longer in some cases if individuals are experiencing sleep apnea one of the problems is that repeatedly this these

repeated disruptions in the sleep can really make them feel very fatigued and tired the next day now one of the

really nasty things about sleep apnea is that in some cases people don't even recognize that they're waking up so for

example if someone stops breathing typically what happens is they wake up for a brief period of time they start

breathing again and then they often will go right back to sleep in some cases people with sleep apnea don't even

recognize that they're having these repeated Awakenings throughout the night and so it may take months or years or

some cases even decades for them to be diagnosed with sleep apnea sleep apnea is more common in people who

are overweight in part because of the fatty tissue around the throat when we're sleeping that fatty tissue kind of

weighs on our Airway and makes it harder for us to breathe there are two types of sleep apnea the

first is obstructive sleep apnea this is when the airway becomes blocked and air is prevented from entering the lungs

this is going to be the type that obesity or Beethoven overweights tends to be more related to this obstructive

type of sleep apnea there's also a central type of sleep apnea which is when the central nervous system fails to

initiate our breathing at appropriate times one of the common treatments of sleep

apnea is to be treated with something called the CPAP machine which is continuous positive airway pressure

basically what happens with the CPAP machine like you can see up here this is a CPAP machine people wear this device

on their face overnight and what it does is it pumps air into the person's Airways to keep air flowing so basically

to keep those air passages open so that people don't stop breathing another issue connected to sleep is

sudden infant death syndrome also known as SIDS this occurs when an infant stops breathing during sleep and dies infants

younger than 12 months of age are at the highest risk of experiencing SIDS boys have a much greater risk than girls do

some of the contributing factors for sudden infant death syndrome or things like premature birth smoking within the

home and also hyperthermia so with the body temperatures too high that also is a contributing factor

um you'll notice that there are certain campaigns that come to prominence at different times about promoting a safe

uh safer sleep positions for children uh currently the the what's believed to be the case is that putting young children

who are less than a year old if they're going to take a nap or go to sleep for the night putting them on their back

seems to be the Sleep the safest sleep position for young children narcolepsy is another sleep disorder

narcolepsy involves an irresistible urge to fall asleep during waking hours this can be triggered by a number of things

including heightened arousal or stress when I was a graduate student at the University of Oklahoma there is an

undergraduate who worked in our lab and she experienced narcolepsy and she she told this story about the first time

that her boyfriend at the time had said that he loved her it was such a it was such an exciting moment for her that it

triggered her narcolepsy and she immediately fell asleep right and those sorts of stories are not uncommon for

people who experience narcolepsy where something really arousing will happen or stressful and the person will

immediately kind of fall into a sleep state and so to Outsiders it may seem kind of

humorous in some cases but for people who suffer from narcolepsy these can be really debilitated this can be a really

debility condition um so narcolepsy is going to share uh some features of grim sleep including

cataplexy so a loss of muscle tone while awake or in some cases complete paralysis of voluntary muscles this is

going to make it uh very difficult for these folks to do and unless they have their narcolepsy in check for example

it's very dangerous for them to do things like operate a car like you shouldn't be driving if you are at risk

of suddenly losing Consciousness for example they also will sometimes experience that nagaga hallucinations

these kind of vivid dreamlike hallucinations even if they aren't in a full sleep state

one of the most common treatments for narcolepsy is to use some sort of stimulant medication the nice thing is

that the medications for narcolepsy have gotten much much better over the years so uh for example some people are able

to resume most of their normal life activities on on some of the current medications and some of the medication

regimens are are structured such that they they produce relatively minor side effects in some people now some people

still have significant side effects or can't find the right kind of medication combination but for some people these

medications have been tremendously effective for them uh here's a a chart of different sleep

stages and when uh are when these sleep problems tend to emerge so for example we see things like sleepwalking 10-speed

stage three stage four so these are happening typically during times when we aren't experiencing dreams right so it

isn't the case that people are sleepwalking in response to dream content most of the time right Rim

theory is when we're experiencing dreams are most likely to be experiencing dreams are happening during this stage

here not down here with sleepwalking night terrors tend to occur during stage four again not a lot of dream content

going on during night terrors nightmares in contrast are typically happening during Rim episodes when we're

having these very Vivid uh powerful sorts of dreams that are more likely to be remembered

there are a number of suggestions that experts have offered for getting a better night's sleep and these are some

of those suggestions so go to bed when you are sleepy one of the problems is that when people start having trouble

sleeping they try to go to bed earlier and earlier and in some cases that isn't terribly effective if you're not sleepy

and ready to go to sleep so if you can't go to sleep within 20 25 minutes or so it may not be and if you're not tired

and not on the verge of falling asleep it may not be a bad idea to get up and do something like reading or watching

some calming television until you're sleeping right you don't want to do something terribly active you want to do

something that's kind of passive and it's likely going to kind of calm you down right this wouldn't be a time to

watch some really engaging kind of gripping television show you certainly shouldn't be exercising or doing

anything of that's what it's going to kind of wake you up you want to avoid doing anything in your

bed other than sleeping um so the idea is to try to associate your bed to sleep not with other

activities like watching TV reading looking over your cell phone any of those sorts of things one exception is

for sex most experts agree that using your bed for sex is perfectly fine it's important not to try too hard to go

to sleep sometimes people will try to kind of will themselves to go to sleep and that typically is not a recipe for

successful uh sleeping um also you shouldn't stare at the clock and start calculating how much sleep you

will get this ends up being one of my problems if I start having trouble sleeping is I'll glance the and see

oh it's two o'clock in the morning now I have to get up at 7 30. so if I go to sleep right this second I can still get

five and a half hours and that is not that is not conducive to sleeping well it just increases our attention and it

makes it harder for us to fall asleep so one of the things that experts recommend is that if you're someone who

has a lot of trouble sleeping what you should probably do is turn your clock away from the bed so that you can't see

it and avoid looking at time related cues because you don't want to stress yourself out because that's going to

keep you awake rather than help you go to sleep right it isn't the case that if you realize oh if I go to sleep right

now I can only get three hours of sleep that isn't helpful that's just going to make it that's going to put more and

more stress on you to go to sleep immediately which is going to paradoxically make it harder for you to

actually go to sleep keeping a regular schedule is really important going to bed and waking up at

the same time each day this is really hard for people to do because people have a natural inclination to go to bed

a little bit later and sleep later on the weekends it's generally and that's perfectly fine

if your sleep is great and you don't have any problems adjusting that's wonderful however if you're someone like

me and you have a lot of trouble with your sleep you may need to keep a regular schedule so every night of the

week I go to bed at the same time I go to bed around 10 10 30 and I get up at the same time every morning regardless

of whether it's Monday morning or Saturday morning and I do that to try to help improve my quality of sleep again

if you're sleeping really well you feel really well rested all the time you're getting plenty of sleep keep doing what

you're doing if you're having problems though keeping a regular schedule is a very common recommendation from Sleep

Experts one of the things that you should definitely try to avoid are things like

taking sleeping pills drinking alcohol or using other drugs that slow down the nervous system

those sorts of drugs can be helpful for getting you into deep sleep but they often don't allow for REM sleep and for

example if you're chronically using sleeping pills or other sorts of medications one of the downsides is that

it may be impairing your REM sleep and over time those sorts of problems can really begin to accumulate and cause

issues so again you want to try to avoid sleeping pills alcohol or other sorts of drugs and focus more on changing your

behaviors to improve your quality of sleep